Professional guidelines have long recommended that physicians screen children for dental disease during routine medical visits. Physicians self-report in national surveys that they are likely to conduct screenings and refer those at high risk for dental disease or already having disease for dental care. Yet the rate at which physicians refer young children with disease, factors associated with these referrals or rates of subsequent visits by children to dentists are not known. We propose to evaluate the screening, risk assessment and referral component of "Into the Mouths of Babes" (IMB), a comprehensive preventive dental program being offered in medical offices across North Carolina for Medicaid-enrolled children birth through 35 months of age. We will use data available from an evaluation of the preventive effects of IMB services to assess the effects of the program on referral for treatment for existing disease. The first aim will assess referral rates among children with an IMB visit and their child-, practice- and county-level predictors. The second aim will determine subsequent use of dental care among Medicaid eligible children who received a referral as part of an IMB visit. The third aim will be an intention-to-treat analysis of the overall effect of IMB in promoting use of dental care for children with existing disease. For this third study, we will use a matching process to generate a 'treatment' and 'control' group of medical practices that did and did not participate in IMB, respectively. We then will compare dental use for the two groups. We will use NC Medicaid medical and dental claims files from October 1999 through December 2005 and patient encounter forms completed by physicians for each child who received IMB services. These data are available as a result of the 5-year IMB demonstration. The encounter forms provide information about physician referrals for dental care, the child's dental risk and disease status, and parent-reported preventive dental behaviors. They have been linked by person ID to Medicaid claims to determine subsequent dental use. We will employ statistical methods for panel data analysis, including multi-level and Cox proportional hazard models, and will address bias due to non-randomness in selection of children to receive IMB services using propensity score methods. Findings from this study will contribute to the evidence for physicians' role in improving access to dental care and oral health status for underserved, low-income children. [unreadable] [unreadable] [unreadable]